Pregnant people
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Key findings
People can experience violence specific to reproductive health and/or pregnancy. This violence can occur in the context of family violence, commonly intimate partner violence, or sexual violence by any perpetrator (see Box 1 for a discussion of the terms used). There can be a range of negative health impacts associated with this violence, including lack of autonomy in reproductive choice, unintended pregnancies, abortions, higher rates of miscarriage, delayed prenatal care, pre-term birth (before 37 completed weeks of gestation) and low birthweight (less than 2,500 grams) (Marie Stopes Australia 2020, WHO 2011, WHO 2021). Previous experience of trauma, including exposure to family and domestic violence during childhood, may also be associated with pregnancy complications, pre-term birth and low birthweight (Mamun et al. 2023) and could contribute to a birth being experienced as traumatic (Highet et al. 2023).
Pregnancy, and the early post-natal period, is a time of heightened risk for the onset or escalation of partner violence (ANROWS 2020, State of Victoria 2016). The experience of violence before, during and after pregnancy has been associated with physical and psychological health problems for both the mother and child (Bayrampour et al. 2018, Brown et al. 2015, Campo 2015, Moore et al. 2017, WHO 2021, Yang et al. 2022).
This section mostly focuses on violence perpetrated by intimate partners but it can also be perpetrated by family members (particularly in relation to reproductive coercion and abuse) or strangers (in relation to sexual violence).
In AIHW’s family, domestic and sexual violence (FDSV) reporting, specific terms are used when reporting from certain data sources. The terms ‘women’ and ‘mothers’ are used throughout this topic for consistency with sources. However, it should be noted that some people may not identify with these terms (see Box 1).
‘Pregnant people’ is a gender-neutral term that may be used to refer to all people who are or have been pregnant, regardless of their gender identity (including for example, people who identify as women, transgender or non-binary). The mechanisms for collecting data on sex and/or gender vary across data collections. In most cases, ‘male’ and ‘female’ are used, however it is not always known whether the data refer to sex at birth or to gender identity and some people may not identify with these terms. AIHW FDSV reporting uses the terms used in the data source, including the terms ‘women’ and ‘mothers’ which some people may not identify with.
The following FDSV-related terms are used in the reporting for this topic:
Intimate partner violence includes both dating violence (violent or intimidating behaviours perpetrated by a current or previous boyfriend, girlfriend or date) and partner violence (violent or intimidating behaviours perpetrated by a current or former cohabiting partner).
Partner violence is reported in the Australian Bureau of Statistics (ABS) Personal Safety Survey (PSS) for:
- 'current partner' – a person who, at the time of the survey, was living with the respondent in a marriage or de-facto relationship.
- 'previous partner' – a person who lived with the respondent at some point in a marriage or de facto relationship, but who was no longer living with the respondent at the time of the survey.
Sexual violence includes sexual assault, sexual threat, sexual harassment, child sexual abuse, street-based sexual harassment and image-based abuse. However, the ABS PSS uses a narrower definition of sexual violence, including only sexual assault and sexual threat. Sexual violence in its broadest form can occur in the context of family or domestic violence or be perpetrated by other people known to the victim or by strangers.
Sexual assault is a type of sexual violence that involves any physical contact, or intent of contact, of a sexual nature against a person’s will, using physical force, intimidation or coercion.
Reproductive coercion and abuse is any interference with a person’s reproductive autonomy that seeks to control if and when they become pregnant, and whether the pregnancy is maintained or terminated. It may include pregnancy coercion, birth control sabotage or controlling the outcome of a pregnancy. Intimate partner violence, including sexual violence, may be a mechanism through which reproductive coercion and abuse is perpetrated. However, perpetrators may also be a family member or a family member of the partner.
- ABS Personal Safety Survey
- Mothers’ and Young People’s Study
- AIHW Burden of disease
- AIHW National Hospital Morbidity Database
- Australian Longitudinal Study on Women’s Health
- Longitudinal Study of Australian Children
What do we know about the experience of FDSV in relation to pregnancy?
How many people experienced violence by a partner during their pregnancy?
The World Health Organisation estimated a prevalence rate for intimate partner violence during pregnancy of around 2% for Australia (WHO 2011). This was based on a secondary analysis of data from the International Violence against Women Survey 2002, which explored the experience of physical and sexual intimate partner violence for 6,700 women who had ever been pregnant (Devries et al. 2010).
A review of studies on the prevalence of intimate partner violence in pregnancy indicated a lack of reliable data for Australia (Román-Gálvez et al. 2021). As a proxy, the ABS Personal Safety Survey (PSS) can be used to report on whether women who experienced partner violence were ever pregnant during the relationship and if violence occurred during pregnancy.
1 in 7 women who experienced violence by a current partner and were pregnant during the relationship, experienced violence during their pregnancy.
According to the 2021–22 PSS, an estimated 124,000 women, who had experienced violence by a current partner since the age of 15, were pregnant during the relationship. Of these women, about:
- 1 in 7 (15%*, or 18,000*) experienced violence during their pregnancy
- 1 in 8 (13%*, or 15,900) experienced violence for the first time during pregnancy (ABS 2023).
Note that estimates marked with an asterisk (*) should be used with caution as they have a relative standard error between 25% and 50%.
17% of women who experienced violence by a previous partner, experienced the violence for the first time during pregnancy.
Of the estimated 791,000 women who had experienced violence by a previous partner since the age of 15 and were pregnant during the relationship about:
- 2 in 5 (42%, or an estimated 329,000 women) experienced violence during their pregnancy
- 1 in 6 (17%, or an estimated 132,000 women) experienced violence for the first time during pregnancy (ABS 2023).
15% of clients of pregnancy counselling and reproductive health services in Australia reported reproductive coercion and abuse.
Reproductive coercion and abuse may include behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion) (Sheeran et al. 2022). A study of around 5,100 clients who sought counselling support for pregnancy from 2 specific providers in Australia between January 2018 and December 2020 investigated the reporting of reproductive coercion and abuse. Fifteen per cent of clients reported reproductive coercion and abuse:
- 6% to promote pregnancy
- 7.5% to prevent pregnancy
- 1.9% to promote and prevent pregnancy (Sheeran et al. 2022).
What are the health service responses to intimate partner violence during pregnancy?
Many pregnant people have regular contact with health-care professionals during pregnancy, which presents an opportunity to identify and respond to violence (AIHW 2015, ANROWS 2020). Perinatal, maternal and child health services are specifically targeted to pregnant people and their children and can play a critical role in early intervention by identifying family and domestic violence (FDV) and providing appropriate referrals (AIHW 2015).
Evidence suggests that screening by health professionals during pregnancy can lead to higher rates of disclosure of, and increases the identification of, domestic violence (O’Reilly et al. 2010). Screening for FDV during pregnancy occurs in most states and territories, however, a variety of FDV screening approaches are used (AIHW 2015). National perinatal data on screening for FDV is not yet available for reporting and little is known about the supports and services provided to people who experience, or are at risk of experiencing, violence during pregnancy (AIHW 2022b).
The National Pregnancy Care Guidelines- external site opens in new window recommend that all people are asked about FDV during pregnancy and that this should only be asked when alone with the person (Department of Health 2020). The 2023 National Perinatal Mental Health Guideline- external site opens in new window also recommends that enquiry about FDV is included as part of psychosocial assessment of factors influencing mental health (Highet et al. 2023).
A variety of FDV screening approaches are used in Australia, including routine and targeted screening and other mechanisms that prompt screening questions, and the use of a variety of screening tools (AIHW 2015). Screening for intimate partner violence typically occurs when a client is asked a series of questions that seek to determine if that person is experiencing, or is at risk of, violence in their intimate relationship (AIHW 2015).
The AIHW National Perinatal Data Collection (NPDC) is a national population-based cross-sectional collection of data on pregnancy and childbirth. In 2020, a voluntary family violence screening question (which is defined as including "Violence between family members as well as between current or former intimate partners") was introduced into the NPDC through the Perinatal National Best Endeavours Data Set (NBEDS) to identify whether screening for FDV was conducted. Due to the time lag between development, implementation and collection of data by the state and territory perinatal data collections and their inclusion in the NPDC, data are not yet available for reporting (AIHW 2023b).
The AIHW is also working with the Commonwealth Department of Health and Aged Care and states and territories to develop the Perinatal Mental Health pilot data collection. This will contain data from perinatal mental health screening conducted in some public maternity hospitals, maternal and child family health clinics, and general practice; and some of the screening tools cover data on FDV risk. Analysis of the pilot will inform decisions about the appropriateness and feasibility of capturing this information on an ongoing basis (AIHW 2022b).
What are the outcomes of violence in relation to pregnancy?
Pregnancy loss or termination
17% of the burden of disease due to early pregnancy loss was attributable to intimate partner violence in 2018.
Intimate partner violence is a major health risk factor for women aged 15 to 44 years, ranking as the fourth leading risk factor for total disease burden in 2018 (see Box 3) (AIHW 2021a).
Burden of disease refers to the quantified impact of living with, or dying from, a disease or injury. Attributable burden is the reduction in burden that would have occurred if exposure to a specific risk factor had been avoided or reduced to its lowest level (AIHW 2021b).
Early pregnancy loss (including termination of pregnancy and miscarriage) is one of the six outcomes linked to intimate partner violence (Ayre et al. 2016).
It was estimated that intimate partner violence contributed to 1.4% of the total burden of disease and injury among Australian women in 2018. Seventeen per cent of the burden due to early pregnancy loss was attributable to IPV (AIHW 2021b). These estimates reflect the amount of disease burden that could have been avoided if all women aged 15 and over in Australia were not exposed to intimate partner violence, including emotional, physical and sexual intimate partner violence by a cohabiting current or previous intimate partner (AIHW 2021b).
The proportion of burden due to early pregnancy loss attributable to IPV was similar between 2015 (18%) and 2018 (17%) (AIHW 2020, 2021b).
Women who experienced violence were twice as likely to terminate a pregnancy.
Associations are made between unintended pregnancy, intimate partner and sexual violence, reproductive control and abuse, and forced termination of pregnancy (Campo 2015, Grace and Anderson 2018, Tarzia and Hegarty 2021). Some international research suggests there may be a repetitive cycle of pregnancy termination in the context of intimate partner violence (Hall et al. 2014). However, there are no nationally representative data available to inform about the extent or impacts of reproductive coercion and abuse in Australia (Carter et al. 2021, Price et al. 2022) or on the incidence or prevalence of abortion (Taft et al. 2019).
The Australian Longitudinal Study on Women’s Health was used to examine factors associated with abortions undertaken for non-medical reasons. The analysis focused on data from the 1973–1978 birth cohort after five surveys and included data for 9,021 women (Taft et al. 2019). Findings indicated that:
- women who reported recent intimate partner violence were twice as likely to terminate a pregnancy than women who did not experience intimate partner violence
- the experience of any interpersonal violence, including recent or past partner violence, and non-partner violence, significantly increased the likelihood of terminating a pregnancy (Taft et al. 2019).
Two studies of Queensland women provide some limited information about intimate partner or sexual violence and unintended pregnancy:
- 12% of first contacts with the service disclosed domestic violence and 3% disclosed sexual assault in a study of 6,200 women seeking information regarding termination of unintended pregnancies in Queensland between July 2012 and June 2017 (Sharman et al. 2019).
- reproductive coercion was reported among 5.9% of women at first contact and 18% of the repeat contacts in a study of 3,100 Queensland women who contacted a telephone counselling and information service regarding an unplanned pregnancy between January 2015 and July 2017 (Price et al. 2022).
Health and wellbeing outcomes
Intimate partner violence may result in unintended pregnancies (Gartland et al. 2011) and the risks (medical conditions) associated with these pregnancies may be greater than those for planned pregnancies (Keegan et al. 2023). Medical conditions as a result of pregnancy may be short-term conditions experienced during pregnancy or conditions that develop after pregnancy and continue in the longer-term. For example, heart conditions, diabetes, high blood pressure, infections, anemia, bleeding, nausea/vomiting, and severe morning sickness (Keegan et al. 2023; NICHD 2020). People who are denied reproductive autonomy and are forced to continue a pregnancy are also denied the right to accept the risks that may be associated with pregnancy.
Violence experienced during pregnancy may result in physical and psychological health problems for both the mother and fetus including low birth weight, premature labour and miscarriage, injuries, fetal stress and trauma, maternal depression, anxiety, and post-traumatic stress disorder (Bayrampour et al. 2018, Brown et al. 2015, Campo 2015, WHO 2021, Yang et al. 2022).
According to the Mothers’ and Young People’s Study (formerly the Maternal Health Study), women who experienced family violence were around twice as likely to give birth to babies with low birthweight (less than 2,500 grams), compared with women who did not experience violence (12% and 4.7%, respectively). Babies born with low birthweight are at higher risk of developing a range of health conditions such as diabetes and hypertension earlier in their life, compared with babies born in the normal weight range (Brown et al. 2015).
People who were afraid of an intimate partner during pregnancy were also more likely to experience vaginal bleeding during pregnancy, urinary and faecal incontinence, and depressive and/or anxiety symptoms (Brown et al. 2015).
Intimate partner violence during pregnancy is also associated with adverse health behaviours during pregnancy, including maternal smoking, alcohol and substance use, and delayed prenatal care (Suparare et al. 2020, WHO 2011). Difficulties or lack of attachment between the mother and child and lower rates of breastfeeding may also be associated with intimate partner violence (WHO 2011).
See also: Children and young people; Mothers and their children.
Following birth, people are generally advised to abstain from sexual intercourse for 4–6 weeks, or until they have a medical check (Piejko 2006). However, some people may be pressured by their partner to resume sexual intercourse before they are physically or emotionally ready (Jambola et al. 2020). Incomplete healing following birth may cause sexual discomfort, infection and tears (Gadisa et al. 2021). This and other common maternal health problems such as tiredness and fatigue may result in sexual dysfunction (Piejko 2006). If birth control has not been resumed, there may also be a shorter interval between pregnancies (Gadisa et al. 2021).
Shorter intervals between pregnancies have commonly been considered to be intervals of less than 18 months from the end of one pregnancy to the start of the next pregnancy. Adverse outcomes that have been associated with shorter intervals between pregnancies include placental abruption, placenta praevia, uterine rupture (for people who previously delivered by caesarean section), gestational diabetes, increased risk of stillbirth, small size for gestational age, preterm delivery and neonatal death (Dorney et al. 2020).
Hospitalisations
-
48%
of pregnant women assaulted by a partner in 2021–22 experienced injury to their trunk, compared with 29% of other women
Source: AIHW National Hospital Morbidity Database
People who experience intimate partner violence during pregnancy are likely to be hit in the abdomen, which not only harms them but also has the potential to endanger the pregnancy (WHO 2011).
In 2021–22, the victim was pregnant in 7% (or about 250) of hospitalisations of women for injuries from assault by a spouse or domestic partner. Two-thirds (67%) of these pregnant women were admitted with injuries to their head and/or neck, and 48% were hospitalised with injuries to their trunk (that is, the thorax, abdomen, lower back, lumbar spine and pelvis). Trunk injuries were more common among pregnant women than among women who were not pregnant (29%) (AIHW 2023a; Figure 1).
Figure 1: Physical assault hospitalisations where perpetrator was spouse or partner, females aged 15 and over, by type of injury, by pregnancy status, 2021–22
| Type of injury | Pregnant | Not pregnant |
|---|---|---|
| Head and/or Neck | 66.9% | 72.5% |
| Trunk | 47.6% | 28.9% |
| Shoulder, arm and/or hand | 27.4% | 38.3% |
| Hip, leg and/or foot | 21.4% | 23.6% |
| Burns | 0.0% | 1.0% |
For more information, see Data sources and technical notes.
Source:
AIHW NHMD
|
Data source overview
Analysis of linked hospital and death data from the National Integrated Health Services Information Analysis Asset found that about 1 in 10 (11%) hospitalisations in which FDV was identified between 2010–11 to 2018–19 had a principal diagnosis of Pregnancy, childbirth and puerperium. For these hospitalisations, Pregnancy, childbirth and puerperium was the diagnosis considered to be mainly responsible for occasioning the hospitalisation (AIHW 2021c).
Intimate partner homicide
The risk of intimate partner homicide may be greater for people who experience violence during pregnancy (Boxall et al. 2022, WHO 2011). Of the 240 female intimate partner homicide victims between 2010 and 2018, five (2.1%) were pregnant at the time that they were killed (ADFVDRV and ANROWS 2022).
Are some pregnant people at greater risk of experiencing FDSV?
Some studies have indicated that certain groups of people are at greater risk of experiencing FDSV during pregnancy and following birth (Campo 2015, Suparare et al. 2020, Toivonen and Backhouse 2018).
Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander (First Nations) people experience higher rates than non-Indigenous people of medical complications in pregnancy, perinatal deaths, preterm birth and babies born with a low birth weight (Weetra et al. 2016). Twenty-eight per cent of the burden due to early pregnancy loss was attributable to intimate partner violence in 2018 for First Nations women (AIHW 2022a). This compares with 15% for non-Indigenous women (AIHW 2021b).
The Aboriginal Families Study examined the social health issues and psychological distress experienced by 344 mothers of Aboriginal babies born in South Australia between July 2011 to June 2013. Findings indicated high rates of social health issues affecting Aboriginal women and families during pregnancy, including issues related to family or community conflict. More than 1 in 3 (36%) women who experienced 3 or more social health issues in pregnancy reported high or very high psychological distress (Weetra et al. 2016). A follow up questionnaire when the children were aged 5-8 years focused on experiences of intimate partner violence, see Mothers and their children.
See also: Aboriginal and Torres Strait Islander people.
Younger people
People aged 18–24 are at greater risk than older people of experiencing intimate partner violence during pregnancy and in early motherhood (Campo 2015). They may also be at greater risk of experiencing reproductive control from an intimate partner, unintended pregnancy and/or forced termination (Campo 2015).
See also: Young women.
People with severe mental illness
Analysis of data extracted from hospital records of around 300 women with severe mental illness (including schizophrenia and related psychotic disorders and Bipolar Disorder) from 1 hospital in Western Australia found that:
- around 48% of pregnant women with severe mental illness had experienced intimate partner violence and were 3 times the risk when compared with the general pregnant population in Australia
- there was no difference in rates of intimate partner violence in women with psychotic disorders when compared with bipolar disorder
- rates of smoking and illicit substance use were significantly higher in pregnant women with severe mental illness who experienced intimate partner violence compared with those who had not experienced IPV (Suparare 2020).
Migrant and refugee people
Migrant and refugee people may have visa restrictions that prevent access to health services, including sexual health, maternal health or abortion services (Marie Stopes Australia 2020). People on a temporary or partner visa may be reliant on a violent partner financially and/or for residency and threats related to deportation may also be used to control them (AIJA 2022, Tarzia et al 2022).
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